Characterization of focal hepatic lesions with duplex sonography: findings in 198 patients

The purpose of this study was to determine the value of duplex Doppler sonography in the characterization of focal hepatic lesions. Duplex Doppler sonography with a 3-MHz transducer was performed prospectively on 198 patients with focal hepatic lesions. One hundred thirty-two patients had pathologically proved diagnoses, confirming 46 hepatomas and 86 metastatic lesions. Twenty-three hemangiomas were confirmed either with tissue, tagged RBC study, MR imaging, or hemangioma CT protocol. Forty-three patients with no history of cancer had benign lesions that were established on the basis of follow-up imaging and at least a 2-year clinical history with no evidence of cancer. Thirty-two hepatomas and four metastatic lesions had Doppler shifts of 4.5 kHz or more, giving a 70% sensitivity, 95% specificity, and 89% positive predictive value in distinguishing hepatomas from metastatic lesions. Forty-three hepatomas, 47 metastatic lesions, one hemangioma, and three benign lesions had Doppler shifts of 1.75 kHz or more, giving a 68% sensitivity, 94% specificity, and 96% positive predictive value in distinguishing malignant from benign lesions. Doppler shifts (mean +/- SD) were as follows: hepatomas, 4.72 +/- 1.72 kHz; metastases, 1.99 +/- 1.63 kHz; and hemangiomas, 0.53 +/- 0.75 kHz. These differences in mean Doppler shifts were statistically significant (p < .0001). Duplex Doppler sonography aids in distinguishing hepatomas from metastases and malignant from benign hepatic lesions with a high degree of specificity but low sensitivity.